Effects of caffeine on the detection of ischemia in patients undergoing adenosine stress cardiovascular magnetic resonance imaging

Journal of Cardiovascular Magnetic Resonance

Research

Stefan Birkmeier¹  Francesco Vecchio²  Heiko Mahrholdt²  Philipp Kaesemann²  Udo Sechtem²  Eed Abu-Zaid²  Andreas Seitz²  Simon Greulich³ 

[1] Division of Cardiology, Kliniken Dr. Müller, Munich, Germany;Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376, Stuttgart, Germany;Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376, Stuttgart, Germany;Department of Cardiology and Cardiovascular Diseases, University Hospital Tübingen, Tübingen, Germany;

关键词: Caffeine;    Ischemia;    Adenosine;    Stress;    CMR;   

DOI  :  10.1186/s12968-017-0412-0

 received in 2017-07-03, accepted in 2017-11-20,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundAdenosine stress cardiovascular magnetic resonance (CMR) can detect significant coronary artery stenoses with high diagnostic accuracy. Caffeine is a nonselective competitive inhibitor of adenosine2A-receptors, which might hamper the vasodilator effect of adenosine stress, potentially yielding false-negative results. Much controversy exists about the influence of caffeine on adenosine myocardial perfusion imaging. Our study sought to investigate the effects of caffeine on ischemia detection in patients with suspected or known coronary artery disease (CAD) undergoing adenosine stress CMR.MethodsThirty patients with evidence of myocardial ischemia on caffeine-naïve adenosine stress CMR were prospectively enrolled and underwent repeat adenosine stress CMR after intake of 200 mg caffeine. Both CMR exams were then compared for evaluation of ischemic burden.ResultsDespite intake of caffeine, no conversion of a positive to a negative stress study occurred on a per patient basis. Although we found significant lower ischemic burden in CMR exams with caffeine compared to caffeine-naïve CMR exams, absolute differences varied only slightly (1 segment based on a 16-segment model, 3 segments on a 60-segment model, and 1 ml in total ischemic myocardial volume, p < 0.001 each). Moreover, no relevant ischemia (≥2 segments in a 16-segment model) was missed by prior ingestion of caffeine.ConclusionsAlthough differences were small and no relevant myocardial ischemia had been missed, prior consumption of caffeine led to significant reduction of ischemic burden, and might lower the high diagnostic and prognostic value of adenosine stress CMR. Therefore, we suggest that patients should still refrain from caffeine prior adenosine stress CMR tests.

【 授权许可】

CC BY   
© The Author(s). 2017